Novel Use of a Disposable Vascular Pressure Device for Arterial Pressure Monitoring in Prehospital Critical Care

Abstract

Introduction Arterial catheterization is a commonly performed procedure in intensive care units (ICUs) to guide the management of critically ill patients who require precise hemodynamic monitoring however this technology is not available in the prehospital setting due to cumbersome and expensive equipment requirements. We compared the accuracy and reliability of a disposable vascular pressure device (DVPD) to the “gold standard”, transducer-pressure bag invasive arterial monitoring system used in intensive care units to determine if the DVPD can be reliably used in place of the traditional pressure transducer set-up. Methods This study was a single-center, prospective, observational study performed in the adult ICUs of a large academic, university hospital. A convenience cohort of hemodynamically stable, adult critically ill patients with femoral, brachial or radial arterial catheters was recruited for this study. The Compass Pressure device is a disposable vascular pressure-sensing device used to assure venous access versus inadvertent arterial access during central line placement. The device is produced by Centurion Medical Products. The DVPD was attached to an in-situ arterial catheter and measures the mean intravascular pressure via an embedded sensor and displays the pressure via the integrated LCD screen. Using a three-way stopcock, the DVPD was compared to a standard arterial set-up. We compared the mean arterial pressure (MAP) in the standard setup to the DVPD using Bland Altman plots and methods that accounted for repeated measures in the same subject. Results Data was collected on 14 of the 15 subjects enrolled (DVPD malfunctioned on one subject). Five measurements were obtained on each patient comparing DVPD to standard arterial set-up at one-minute intervals over the course of five minutes. A total of 70 observations were made. Among the 15 subjects, most (10 (67%)) were radial or brachial sites. The average MAP scores and standard deviation values (SD) obtained by the standard set up were 83.5 mmHg (14.8) and 81.1 mmHg (19.3) by the DVPD. Just over half (51.4%) of measurements were within +/-5 mmHg difference. Using Bland Altman plotting methods, standard arterial measurements were 2.4 mmHg higher (95% confidence interval: 0.60, 4.1) than the DVPD. Differences between the two devices varied significantly across MAP values. The standard arterial line measurements were significantly higher than the DAPD at low MAP values, whereas at the DAPD was measurements were significant higher at high MAP values. Conclusions The DVPD provides an acceptable estimate of mean arterial pressure and may be suitable for arterial pressure monitoring in settings where standard monitoring set-ups are not available. The DVPD appears to provide “worst case” values as it underestimates low arterial BP and overestimates high arterial BP. Future trials should investigate the DVPD in hypotensive patients and patients with laminar flow/low pulsitility, such as ventricular assist devices and extracorporeal membrane oxygenation (ECMO).. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14